On her first visit, a patient had a baseline hemoglobin of 13.0 gm and a hematocrit of 42.9%.She has been taking ferrous sulfate tablets and eating an iron-rich diet.She returned to the clinic at 30 weeks gestation and has a hemoglobin of 11.0 gm and a hematocrit of 36.3%.She is concerned and confused about why these lab values have gone down.
In responding, which physiological change during pregnancy should the nurse describe to the patient?

The correct answer is choice D. Presence of human chorionic gonadotropin (hCG) in blood.This is apositive sign of pregnancythat can only be attributed to a fetus.hCG is a hormone produced by the placenta that can be detected in blood or urine tests.

Choice A. Quickening.This is apresumptive sign of pregnancythat is based on the woman’s report of feeling fetal movements in her lower abdomen.This can occur at 16 weeks for second time moms and around 20 weeks for first time moms.However, this sign is not conclusive as other conditions can cause similar sensations.

Choice B. Uterine enlargement.This is aprobable sign of pregnancythat can be observed by the nurse or doctor through palpation.However, this sign does not mean 100% that a baby is growing in the uterus as it can be due to other causes such as fibroids or tumors.

Choice C. Urinary frequency.This is apresumptive sign of pregnancythat is based on the woman’s report of needing to urinate more often than usual.This can be caused by hormonal changes and increased blood volume during pregnancy.However, this sign is not definitive as other conditions such as urinary tract infections or diabetes can also cause frequent urination.

A transverse lie means that the baby is lying sideways across the uterus, instead of head-down or breech.

This position makes vaginal delivery impossible and increases the risk of umbilical cord prolapse, which can compromise fetal oxygen supply.Therefore, a cesarean delivery is indicated for a fetus in a transverse lie.

Choice A is wrong because having extremely slender hips does not necessarily mean that a woman cannot deliver vaginally.

The size and shape of the pelvis, not the external appearance, determines the adequacy of the birth canal.A trial of labor may be attempted for women with borderline pelvic measurements.

Choice C is wrong because fetal hyperactivity is not a reason for a cesarean delivery.

Fetal movements may vary depending on the time of day, maternal activity, maternal blood sugar level, and other factors.Fetal well-being can be assessed by fetal heart rate monitoring and biophysical profile.

Choice D is wrong because having a posterior cervix does not indicate the need for a cesarean delivery.

A posterior cervix means that the cervix is tilted toward the back of the uterus, which may make cervical dilation slower and more painful.However, with adequate contractions and maternal pushing, the cervix can move to an anterior position and allow vaginal delivery.